Ask Dr. Swiner- Updates on Birth Control

In a recent “Ask Dr. Swiner” segment that I do on my Facebook page, I had a number of interesting questions about what’s new in birth control. I deal with this issue frequently in my practice, and even I have to make sure I’m up to date with the information that comes out.

 The Good Ole’ Pill

For years, we’ve had birth control pills of many types. Most pills come in a variety of levels of estrogen and progesterone that balance one another and allow a woman to have monthly, regular menstrual cycle. Some pills, if taken without the placebo pill (the ones at the end of the pack that are usually a different color), allow a woman to have only 3 menstrual cycles a year, such as Seasonale and Seasonique. We’ve had the patch, the ring, the shot, the implant, and the pill for a number of years. But most recently, IUDs have become all the rage.

IUDs

Intrauterine devices(IUDs), such as the Mirena and the Paragard (copper-IUDs), are one of the “hands off” methods, in that the woman doesn’t have to do anything, except wear a condom to prevent STDs, of course. A doctor places the plastic device into the uterus during an office visit, and that’s it essentially. When the woman is ready to have it removed at 5 years (Mirena) or 10 years (Paragard), the doctor takes it out. Recently, the complaint I’ve heard from women about the IUD is that it appears to thin their hair, which might, theoretically, occur with any hormonal option or for other reasons if they’re postpartum.

 What can be unpredictable about Mirena IUD’s is the way a woman’s cycle might change once it’s placed. Because it’s made primarily of progesterone and does not have estrogen, like most pills, to balance it, it can change the timing of menstrual cycles. What I tell most women is about the rule of thirds. Approximately, 1/3 of women with the IUD may have their normal, monthly cycles; 1/3 may have no cycles (which is usually what the majority of women hope for); 1/3 may have variable, unpredictable cycles. We don’t know which group you’ll end up in until we place the device. In most cases, however, women are pleased with this method of birth control.

 Norplant and Implanon—the implant form of birth control 

 Norplant was out a couple of years ago, and it is known as the implant that is placed under the skin of the arm and lasted for up to 5 years. It was a 5-rod method made primarily of a progesterone-related hormone, like the IUD, meaning it may have the same effect on bleeding. This was taken off the market about 4 years ago, and now we have Implanon, which is the “new and improved” version. This one lasts for up to 3 years and has to be removed after this point. Instead of 5 rods, Implanon only has one and appears to have less bleeding variability, less bone loss concern, and less weight gain than some of its counterparts. I was recently trained to place this method, and it seems to be a good alternative to the Depo-Provera injection (“Depo shot”) for women who may want to try something different.

 Essure—the new way to get those tubes tied!

 The newest one that I’ve heard about is Essure. Instead of going into an operating room and having a bilateral tubal ligation (BTL), or getting your “tubes tied”, this is an outpatient version of the procedure. It involves the release of small metal coils into the fallopian tubes to block fertilization. It is irreversible. The usual surgery that is done to have a tubal ligation is now possibly reversible, depending on how the surgery was done and who performed it. And then, finally, there is another type of outpatient surgery. One that doesn’t involve female anatomy—and that’s a vasectomy.

 Be healthy and be blessed,

 Dr. Swiner

C.Nicole Swiner, MD is currently a Family Physician in Durham, NC, and has worked in a clinic owned by the University of North Carolina since 2007, after completing her residency training there. She received her undergraduate degree from Duke University.

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